胫骨横向搬移技术治疗糖尿病足的临床疗效

Clinical observation of the treatment of diabetic foot with transverse tibial bone transport

目的对比分析胫骨横向搬移技术治疗与球囊介入治疗及常规治疗对糖尿病足的临床效果。方法选取自2016年6月—2018年10月研究中心收住的45例糖尿病足患者,采用随机数字法分为球囊介入治疗组、胫骨横向搬移组和常规治疗组,每组各15例,常规治疗组给予患者临床基本治疗,其余两组患者在常规治疗的基础上行球囊介入治疗或胫骨横向骨搬移术。采用血管彩超检测各组患者治疗前后足背动脉流速,记录两组治疗前后患侧肢体的踝肱指数(ABI)及治疗前后患者患肢足部皮温、VAS疼痛评分,观察患者足部溃疡面愈合情况,对比各种方法的临床疗效。结果45例病例均得到随访,随访时间平均为6.7月(4~10月)。胫骨横向搬移技术及球囊介入疗法的术后患足ABI、足背动脉血流速度均明显优于常规治疗组(P<0.05);术后足部皮温改变及疼痛评分也明显优于常规治疗组(P<0.05);胫骨横向搬移术术后皮温及术后ABI略优于球囊介入治疗(P<0.05),在术后疼痛VAS评分及术后足背动脉血流速度改善方面,两者疗效相近(P>0.05)。结论胫骨横向搬移术及球囊介入治疗相比于常规基础治疗,均能重建糖尿病足的下肢血供,缓解疼痛的同时促进溃疡面愈合。胫骨横向搬移术的术后皮温及术后ABI优于球囊介入治疗。

Objective To compare the clinical effects of transverse tibial bone transport,interventional therapy and conventional therapy on diabetic foot.Methods We selected 45 diabetic foot patients admitted to the research center from June 2016 to October 2018.We adopted the random number method and divided them into the interventional treatment group,transverse tibial bone transport group and conventional treatment group,with 15 patients in each.Patients in each group received routine clinical treatment,interventional treatment or lateral tibial transposition.Doppler ultrasound was used to measure and monitor the blood flow velocity of dorsal artery before and after treatment.Each group was recorded for the highest systolic blood pressure of the malleolus artery and the highest systolic blood pressure of the brachial artery to measure the malleolus brachial index(ABI),the skin temperature and pain VAS scores of the affected limbs and feet before and after surgery.The healing of ulcerated foot surface was observed before and after operation to evaluate the clinical therapeutic effects of these methods.Results All the 45 patients were followed up for an average of 6.7 months(4-10 months).Compared with those in conventional treatment group,the postoperative ABI and the blood flow velocity of the dorsal artery in interventional treatment group and transverse tibial bone transport group were significantly better(P<0.05).Postoperative skin temperature changes and pain VAS scores were also significantly better than those in conventional treatment group(P<0.05).Compared with the interventional treatment,the postoperative skin temperature and brachial-ankle index ABI in transverse tibial bone transport group were slightly better(P<0.05).And the two had similar efficacy in postoperative pain VAS score and dorsal foot artery blood flow velocity improvement(P>0.05).Conclusion Compared with conventional basic treatment,transverse tibial bone transport and interventional treatment can significantly improve the blood flow parameters of diabetic foot patients,relieve the pain of the patients and promote the healing of ulcer surface.Transverse tibial bone transport is more effective,and its postoperative skin temperature and postoperative brachial-ankle index are better than those of interventional treatment.